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Tennessee rates for HCPCS L3675

Shoulder orthosis (SO), vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.04 / $87.04 / $95.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.73 / $88.65 / $162.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.28 / $174.12 / $174.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.39 / $107.42 / $153.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $78.42 / $107.42
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.30 / $899.40 / $899.40
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$968.61 / $968.61 / $1,408.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.13 / $85.00 / $103.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.34 / $92.91 / $129.18